F:M depression
2:1
Screening questions for depression
- Over last mo, have you been bothered by feeling down, depressed or hopeless?
- over the last mo, have you been bothered by having little interest or pleasure in doing things?
Core sx of depression
- persistent low mood
- loss of interest/pleasure
- fatigue
Other sx of depression
disturbed sleep poor concentration low self esteem change in appetite suicidal thoughts feeling of worthlessness/guilt
DSM IV use
assesses number of core and general sx of depression present
What is sub threshold depression
4 or fewer of DSM IV depression sx is sub threshold depression
What is Dysthymia
Sub threshold depression persisting for 2 yrs
aka chronic subthreshold depression
What is the questionnaire for depression
PHQ-9
Stepped care model of depression mx
Step 1: known or suspected presentations of depression
Step 2: persistent sub threshold or mild to moderate depression
Step 3: persistent sub threshold or mild to moderate depression with inadequate response to step 2 and Moderate to severe depression
Step 4: Severe and complex depression; severe self-neglect
Step 1 mx of depression
Support,
Psychoeducation
Active monitoring
Step 2
low intensity psychological interventions (eg Cognitive behavioural therapy, CBT or structured group physical activity programme)
Consider meds/referral if sx persist
Step 3
- Meds
- high intensity psychological interventions (one to one psychotherapy)
Step 4
- meds
- high intensity psychological interventions (one to one psychotherapy)
- electroconvulsive therapy
- crisis services
- in patient care
Problem solving therapy
step 2 mx
- write a list of problems,
- rank them in order of importance
- suggest solutions
Cognitive behavioural therapy (CBT)
- changing the way pt think/react
- may involve systemic desensitisation (behavioural method)
- or focussing on peoples thoughts and reasoning to challenge assumptions
Mindfullness based cognitive therapy
for people who are well currently but have a hx of 3 prvs depressions
How long do most antidepressants take to work
1-2 wks
How long for antidepressants to reach their peak effect
4-6 wks
When most SEs of antidepressants start to ease
2 wks post start
Main SEs of most antidepressants
GI problems:
- nause
- dry mouth
Increased anxiety
Monitoring after starting on antidepressants
Every 2 peaks until stable
Unless <30 or increased risk of suicide (every 1 wk)
How long should a course of antidepressants be
6 mo, but can be longer if they opt for it
- if 2 or more episodes of major depression, then 2 yrs
Discontinuation reaction to antidepressants
- if used more than 2mo, then suddenly stopped
- sx include headache, nausea, paraesthesia, dizziness, anxiety
How to avoid discontinuation reaction to antidepressants
weaning off over a period of about 1 mo
